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House Structure Is Associated with Plasmodium Falciparum Infection in a Low-Transmission Setting in Southern Zambia

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House Structure Is Associated with Plasmodium Falciparum Infection in a Low-Transmission Setting in Southern Zambia Messiah University Mosaic Biology Educator Scholarship Biological Sciences 2016 House Structure is Associated With Plasmodium Falciparum Infection in a Low-Transmission Setting in Southern Zambia M. M. Ippolito K. M. Searle H. Hamapumbu T. M. Shields J. C. Stevenson See next page for additional authors Follow this and additional works at: https://mosaic.messiah.edu/bio_ed Part of the Biology Commons Permanent URL: https://mosaic.messiah.edu/bio_ed/112 Recommended Citation Ippolito, M. M.; Searle, K. M.; Hamapumbu, H.; Shields, T. M.; Stevenson, J. C.; Thuma, Philip; and Moss, W. J., "House Structure is Associated With Plasmodium Falciparum Infection in a Low-Transmission Setting in Southern Zambia" (2016). Biology Educator Scholarship. 112. https://mosaic.messiah.edu/bio_ed/112 Sharpening Intellect | Deepening Christian Faith | Inspiring Action Messiah University is a Christian university of the liberal and applied arts and sciences. Our mission is to educate men and women toward maturity of intellect, character and Christian faith in preparation for lives of service, leadership and reconciliation in church and society. www.Messiah.edu One University Ave. | Mechanicsburg PA 17055 Authors M. M. Ippolito, K. M. Searle, H. Hamapumbu, T. M. Shields, J. C. Stevenson, Philip Thuma, and W. J. Moss This article is available at Mosaic: https://mosaic.messiah.edu/bio_ed/112 Am. J. Trop. Med. Hyg., 97(5), 2017, pp. 1561–1567 doi:10.4269/ajtmh.17-0299 Copyright © 2017 by The American Society of Tropical Medicine and Hygiene House Structure Is Associated with Plasmodium falciparum Infection in a Low-Transmission Setting in Southern Zambia Matthew M. Ippolito,1* Kelly M. Searle,2 Harry Hamapumbu,3 Timothy M. Shields,2 Jennifer C. Stevenson,3,4 Philip E. Thuma,3 and William J. Moss2; for the Southern Africa International Center of Excellence for Malaria Research 1Divisions of Infectious Diseases and Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; 2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; 3Macha Research Trust, Macha Hospital, Choma District, Zambia; 4The W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland Abstract. House structure may influence the risk of malaria by affecting mosquito entry and indoor resting. Identifi- cation of construction features associated with protective benefits could inform vector control approaches, even in low- transmission settings. We examined the association between house structure and malaria prevalence in a cross-sectional analysis of 2,788 children and adults residing in 866 houses in a low-transmission area of Southern Province, Zambia, over the period 2008–2012. Houses were categorized according to wall (brick/cement block or mud/grass) and roof (metal or grass) material. Malaria was assessed by point-of-care rapid diagnostic test (RDT) for Plasmodium falciparum.We identified 52 RDT-positive individuals residing in 41 houses, indicating an overall prevalence in the sample of 1.9%, ranging from 1.4% to 8.8% among the different house types. Occupants of higher quality houses had reduced odds of P. falciparum malaria compared with those in the lowest quality houses after controlling for bed net use, indoor insecticide spraying, clustering by house, cohabitation with another RDT-positive individual, transmission season, ecologic risk defined as nearest distance to a Strahler-classified third-order stream, education, age, and gender (adjusted odds ratio [OR]: 0.26, 95% confidence interval [CI]: 0.09–0.73, P = 0.01 for houses with brick/cement block walls and metal roof; OR: 0.22, 95% CI: 0.09–0.52, P < 0.01 for houses with brick/cement block walls and grass roof). Housing improvements offer a promising approach to vector control in low-transmission settings that circumvents the threat posed by insecticide resistance, and may confer a protective benefit of similar magnitude to current vector control strategies. INTRODUCTION window screening or other entry barriers compared with those that did not.11–14 Malaria remains an important cause of morbidity and mor- However, studies in sub-Saharan Africa that examined as- tality in endemic regions worldwide, and vector control strat- 1,2 sociations of wall and roof construction with malaria have egies are vital to control and elimination efforts. The two yielded equivocal results. About half of the studies demon- predominantly deployed vector control measures are indoor strated an association, among which wall material appeared residual spraying (IRS) of insecticides and insecticide-treated fl 15–38 3 to be more in uential than roof material. Results of bed nets (ITNs). The emergence of insecticide resistance and studies that applied adjusted models to account for age, changes in behavior of mosquitoes to avoid contact with in- gender, ITN use, ecologic variables, and socioeconomic in- secticides may threaten the efficacy of IRS and ITNs, creating 4 dicators were somewhat more conclusive; most demon- appeal for additional approaches to prevent malaria. strated a significant protective effect of high-quality walls Malaria is transmitted by female anopheline mosquito ranging from 24% to 63% reduction in the risk or odds of vectors that generally prefer to feed in the late evening and malaria, and half showed a protective effect of high-quality night and exhibit endophagic (indoor feeding) behavior, roofs ranging from 15% to 62% reduction.27–37 making the house a potentially high-risk transmission envi- 5 Results of a cross-sectional analysis of housing, grouped ronment. Housing features that impede mosquito entry and by wall and roof type, and malaria in a low-transmission area of indoor mosquito resting are, therefore, likely to diminish oc- southern Zambia are presented. Survey data and field ob- ’ 6,7 cupants risk of malaria. Indeed, housing improvements servations were analyzed from participants living in various such as window and door screening played an important role house types to inform potential approaches to housing inter- fi in malaria control programs during the rst half of the twentieth ventions for vector control against malaria in Zambia and century in North America and Europe before the widespread similar low-transmission settings in sub-Saharan Africa. 8 fi use of insecticides. The rst such experiments were con- Higher quality housing was hypothesized to correlate with ducted over a century ago by Angelo Celli in Italy, who rec- reduced prevalence of malaria compared with lower quality fi ognized malaria as a disease of poverty and identi ed poor housing. housing as a modifiable risk factor.9,10 More recently, his re- sults were recapitulated in a small number of trials done in sub- Saharan Africa where malaria remains endemic, showing METHODS reduced numbers of indoor anopheline mosquitos and lower prevalence of childhood anemia in houses that received Study site. The study was conducted in a 1,200 km2 region east of Macha Hospital in Choma District, Southern Province, Zambia. The area lies at an altitude of 1,000 m above sea level * Address correspondence to Matthew M. Ippolito, Divisions of and the local biome is mainly Miombo woodland. The rainy Infectious Diseases and Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, 1830 E. season is from November to April, followed by a cool, dry Monument Street, Room. 450-B, Baltimore, MD 21231. E-mail: season from April to August and a hot, dry season from August [email protected] to November.39 The inhabitants are traditional villagers living 1561 1562 IPPOLITO AND OTHERS in homesteads consisting of one or more houses where a sampling frame for the random selection of homesteads. members of a family or extended family reside. In general, the Images were imported into ArcGIS 9.2 (Redlands, CA) and houses in the study area have doors or other makeshift bar- homestead locations were identified, manually enumerated, riers. Windows, when present, rarely have glass or screens but and randomly selected from the sampling frame for some windows have curtains. Eaves, a gap between the roof assignment to either the cross-sectional survey or the longi- and top edge of the wall, are open in nearly all houses con- tudinal cohort. The field team was provided with maps and structed with grass roofs, whereas most houses with metal Global Positioning System coordinates of the randomly roofs have closed eaves. selected homesteads. Transmission intensity in the study area is low. During the For each study visit, permission was obtained from the head study period, the entomological inoculation rate was < 1 in- of household, individual residents of the homestead were fective bite per person per season.40 The predominant malaria enumerated, and written informed consent was obtained from vector is Anopheles arabiensis.40 Vector control efforts in- each adult participant, or from the participant’s parent or clude distribution of ITNs, with little IRS having been carried guardian for children £ 18 years. Surveys were administered to out in the Macha area. Malaria control efforts include case gather individual-level demographic information and ITN use, management with artemisinin-based combination therapy, and house- and homestead-level information including prior introduced in Zambia in 2002 and into the study area in application of IRS, educational achievement of the head of the 2004.41,42 household, and availability of flush toilet and electricity. ITN Study design. The study was conducted within the context use was determined by an affirmative answer to the survey of an epidemiologic survey of malaria using data collected item, “Do you sleep under a bed net?” Homestead distance to from February 2008 to February 2012.43 Homesteads in the Strahler-classified third-order water streams (i.e., formed by study region were randomly assigned to either a cross- the convergence of two second-order streams, which in turn sectional sample or longitudinal cohort.
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